Claim edit: Reserved X12 delimiter in a field value
Stedi now rejects 837P professional, 837D dental, and 837I institutional claims with a field value that contains a character reserved as an X12 delimiter.
How the edit works
X12 standards require that a small set of characters be used only to mark the boundaries between segments, elements, and components. Stedi rejects a claim when one of them appears inside a field value: asterisk (*), greater-than sign (>), caret (^), grave accent (`), colon (:), or tilde (~).
The edit checks every text field in the claim. Characters that aren't delimiters pass – the apostrophe in O'BRIEN and the hyphen in SMITH-JONES CLINIC are both valid.
A reserved character inside a value collides with those boundaries, so the claim can't be read as valid X12. If a field value contains one, the payer may reject the claim.
This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.
Rejection errors
How you get the error depends on how you submit the claim.
If you submit a claim using the Create Professional Claim (CMS-1500) JSON endpoint and the claim fails the edit, you'll get back a 201 response with an errors array in real time:
{
"errors": [
{
"description": "Invalid character. The Subscriber First Name (2010BA/NM1-04) contains a reserved X12 delimiter character (greater-than sign). Correct and resubmit."
}
]
}If you submit a claim using Stedi's other Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:
{
"errors": [
{
"code": "33",
"description": "Invalid character. The Subscriber First Name (2010BA/NM1-04) contains a reserved X12 delimiter character (greater-than sign). Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message.
STC*A7>481>HK*[DATE]*U*[AMOUNT]********Invalid character. The Subscriber First Name (2010BA/NM1-04) contains a reserved X12 delimiter character (greater-than sign). Correct and resubmit.~The error names the field and the character, but never repeats the value you submitted – that would put the delimiter back into the acknowledgment.
If more than one field in a claim contains a reserved character, you get one rejection per field.
Related claim edits
Stedi has another edit for field values that run longer than the maximum length allowed by X12 standards. See Claim edit: Field values longer than maximum length.